| NPI | 1790327914 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: KY TC978) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IN 1157474) |
| Enumeration Date | 2019-10-09 |
| Last Update Date | 2021-02-01 |